Registration form

Last name(s) :	MF
First name(s) :
Title :
Date of birth (Year,month,day):
Year of PhD :	or PhD-student :
Institution :
Address :
Country :
Nationality :
Tel :			Fax :
e-mail :
Accompanying person(s):

Do you want to give a talk ?				YesNo
Do you request a reduced fee and a student room ? (*)				YesNo

Number of bicycles requested ?

Payment will be done :		by bank transfer		by credit card

(in case of payment by credit card, fill out the appropriate form and send it to us by letter or by fax)



(*) If so, please submit a curriculum vitae, either electronically or by mail, after checking the appropriate information.